Work

Discharge NT-proBNP predicts 2-year outcomes after TAVR but not after SAVR in preserved ejection fraction: a propensity-matched cohort study

Year: 2026

Type: article

Abstract: Background Discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a recognised prognostic marker after transcatheter aortic valve replacement (TAVR), but its value after surgical aortic valve replacement (SAVR) remains uncertain, possibly reflecting differences in perioperative physiology.Aims To compare the prognostic utility of discharge NT-proBNP after TAVR versus SAVR in patients with severe aortic stenosis and preserved ejection fraction, and to examine the association between NT-proBNP reduction and Left Ventricular Mass Index (LVMI) regression.Methods This propensity-matched cohort study included 556 patients (TAVR, n=278; SAVR, n=278) with left ventricular ejection fraction ≥50% treated at a single centre (2019–2023). The primary endpoint was a 2-year composite of all-cause death or heart failure rehospitalisation.Results After matching, baseline characteristics were well balanced. Discharge NT-proBNP >1000 pg/mL predicted lower event-free survival after TAVR (77.3% vs 91.4%; adjusted HR 3.21, 95% CI 1.96 to 5.26, p<0.001) but not after SAVR (83.8% vs 86.7%; adjusted HR 1.18, p=0.50; p for interaction=0.008). Longer aortic cross-clamp time progressively abolished NT-proBNP prognostic value in SAVR. NT-proBNP reduction correlated with LVMI regression regardless of procedure (β=2.2 per 10% ΔNT-proBNP%, p<0.001). A 6-month NT-proBNP ≤1000 pg/mL identified favourable outcomes irrespective of procedure (adjusted HR 0.51, p=0.002).Conclusions Discharge NT-proBNP predicts outcomes after TAVR but not SAVR, likely due to cardiopulmonary bypass-induced inflammation. NT-proBNP reduction correlates with LVMI regression irrespective of procedure. Risk stratification may be optimised by discharge measurement after TAVR and 6-month reassessment after SAVR.

Source: Open Heart

DOI: 10.1136/openhrt-2026-004319